早期食管癌合并多原发癌的内镜和病理特征及危险因素分析

Endoscopic and pathological features and risk factors for early esophageal cancer combined with multiple primary cancer

摘要:

目的 探究早期食管癌合并多原发癌的内镜和病理特征及其发生的独立危险因素。方法 回顾性收集324例2013年1月到2022年1月在北京友谊医院诊断为早期食管癌的患者的内镜和病理特征，采用多因素logistic回归分析筛选早期食管癌合并多原发癌的独立危险因素。结果 324例早期食管癌患者中47例（14.51%）患者合并多原发癌，其中29例为同时性多原发癌，18例为异时性多原发癌。多因素logistic回归分析表明饮酒≥5个标准饮酒单位/日（OR=6.23， 95%CI： 2.49~15.57， P<0.001）、肿瘤浸润深度达黏膜下层（OR=2.80，95% CI： 1.07~7.30， P=0.036）、病灶位于食管下段（OR=4.18，95%CI： 1.98~8.97，P<0.001）以及食管存在多灶病变（OR=3.30， 95%CI： 1.57~6.92，P=0.002）是早期食管癌合并多原发癌的独立危险因素。结论 饮酒≥5个标准单位/日、肿瘤浸润黏膜下层、病灶位于食管下段，以及存在多灶病变的早期食管癌患者更易合并多原发癌。建议对具有上述因素的患者重点监测，加强内镜随访和评估。

Abstract:

Objective To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer. Methods Endoscopic and pathological features of 324 patients diagnosed as having early esophageal cancer from January 2013 to January 2022 in Beijing Friendship Hospital were retrospectively collected. Independent risk factors for early esophageal cancer combined with multiple primary cancer were selected by multivariate logistic regression analysis. Results Among the 324 patients with early esophageal cancer, 47 (14.5%) patients (29 metachronous and 18 synchronous) had multiple primary cancer. Multivariate logistic regression analysis showed that alcohol drinking ≥5 standard drinks/day (OR=6.23, 95% CI: 2.49-15.57, P<0.001), submucosal layer invasion (OR=2.80, 95%CI:1.07-7.30, P=0.036), lesion location at lower esophagus (OR=4.18, 95%CI: 1.98-8.97, P<0.001) and multiple lesions in esophagus (OR=3.30, 95%CI:1.57-6.92, P=0.002) were independent risk factors for early esophageal cancer combined with multiple primary cancer. Conclusion Alcohol drinking ≥5 standard drinks/day, submucosal layer invasion, lower lesions location, and multiple lesions in the esophagus are independent risk factors that are more likely to develop multiple primary cancer in patients with early esophageal cancer. It is recommended to prioritize monitoring patients with these factors, and enhance endoscopic follow-up and assessment.